Transverse fractures of the proximal half of the distal phalanx are not
well-suited to nonoperative treatment when there is no direct contact between
the fragments. These fractures are often unstable and, in open fractures, the
nail bed is often folded into the fracture. In these cases, open reduction and
internal fixation are indicated.

Insert a needle with a 5-0 nonresorbable nylon suture from the dorsal aspect
into the sinus, exiting the sinus distally to the eponychium.

Pass the needle through the proximal edge of the nail plate.
Then pass the needle back through the nail plate and the sinus of the nail, so
that it exits level with the first pass of the suture, separated from it by
approximately 5 mm.

Draw the nail plate back into the sinus by gentle traction on both ends of
the suture.
Tie the suture over a cotton, or foam, ball to avoid skin pressure injury.